How do I perform an aural toilet (ear cleaning)?

From the Guidelines

To perform an aural toilet (ear cleaning) at home, use a solution of equal parts white vinegar and rubbing alcohol or hydrogen peroxide, and avoid inserting cotton swabs or other objects into the ear canal, as recommended by the most recent guidelines 1. When performing an aural toilet, it is essential to prioritize caution and follow evidence-based guidelines to minimize the risk of complications, such as pushing wax deeper into the ear canal or damaging the eardrum.

Key Considerations

• Never insert cotton swabs, hairpins, or other objects deep into the ear canal, as this can cause injuries or worsen cerumen impaction by pushing cerumen deeper into the canal 1.
• Use a solution of equal parts white vinegar and rubbing alcohol or hydrogen peroxide, and tilt your head with the affected ear facing up to allow the solution to flow into the ear canal 1.
• For irrigation, use a bulb syringe filled with body-temperature water to gently flush the ear canal while tilting your head over a sink, and avoid using high-pressure settings or directing the water longitudinally down the canal toward the tympanic membrane 1.
• If you experience pain, dizziness, hearing loss, or have a history of ear surgery or perforated eardrum, stop immediately and consult a healthcare provider, as these may be signs of complications or underlying conditions that require professional attention 1.

Additional Recommendations

• Professional ear cleaning is recommended for impacted wax, as ears are typically self-cleaning and only the outer portion should be cleaned with a washcloth 1.
• Patients with risk factors such as diabetes or immunocompromised state, as well as those with established malignant otitis externa, may require atraumatic cleaning with aural suctioning under microscopic guidance 1.
• It is crucial to follow the package instructions for over-the-counter ear drops like Debrox and to use them as directed to avoid any potential harm or complications 1.

From the FDA Drug Label

Directions FOR USE IN THE EAR ONLY. Adults and children over 12 years of age: Tilt head sideways and place 5 to 10 drops into ear Tip of applicator should not enter ear canal Keep drops in ear for several minutes by keeping head tilted or placing cotton in the ear Use twice daily for up to 4 days if needed, or as directed by a doctor Any wax remaining after treatment may be removed by gently flusing the ear with warm water, using a soft rubber bulb ear syringe To perform an aural toilet (ear cleaning), follow these steps:

• Tilt your head sideways and place 5 to 10 drops of the solution into your ear.
• Keep the tip of the applicator out of the ear canal.
• Hold the drops in your ear for several minutes by keeping your head tilted or placing cotton in the ear.
• Use the solution twice daily for up to 4 days if needed, or as directed by a doctor.
• If wax remains after treatment, it may be removed by gently flushing the ear with warm water using a soft rubber bulb ear syringe 2

From the Research

Aural Toilet (Ear Cleaning) Procedure

To perform an aural toilet, the following steps can be considered:

• Dry mopping with cotton wool or tissue paper to remove mucopurulent discharge 3
• Suction clearance, typically under a microscope, to remove epithelial debris or thick pus 3
• Irrigation using manual or automated syringing to clean the ear canal 3

Precautions and Considerations

When performing aural toilet, the following precautions should be taken:

• Be aware of the potential for adverse effects, such as vertigo, dizziness, or balance problems, especially in patients with mastoid cavities 4
• Use caution when performing long-lasting suction periods straight in front of the eardrum without sound-protecting earwax between the sucker and eardrum 5
• Avoid performing suction procedures when "clarinet phenomena" are occurring, as this can generate high peak noise levels 5
• Consider using micro-forceps or other non-suctioning instruments to clean the auditory canal in the presence of dermal flakes blocking the canal 5

Effectiveness of Aural Toilet

The effectiveness of aural toilet in resolving ear discharge in people with chronic suppurative otitis media (CSOM) is uncertain due to a lack of data and poor quality of available evidence 3

• Daily aural toileting (dry mopping) may not be significantly different from no treatment in terms of resolution of ear discharge 3
• Daily suction clearance followed by antibiotic ear drops administered at a clinic may not be significantly different from a single episode of suction clearance followed by self-administration of topical antibiotic ear drops 3

Importance of Aural Toilet

Aural toilet is an important step in the diagnosis and management of ear discharge, as it allows for a more precise diagnosis and better access for therapeutic agents 6